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目的:研究妊娠晚期宫颈高危型人乳头状瘤病毒(HR-HPV)感染与自然转归状况。方法:选取2013年5月~2014年5月于我院接受孕期产检与分娩的产妇2875例,分别于孕前1年和分娩前行液基细胞学检测与宫颈HR-HPV DNA检测。统计HR-HPV的感染率与影响因素,通过随访了解自然转归状况,对持续感染者行病理学、阴道镜、细胞学检查。结果:共530例孕妇感染HPV,感染率为18.4%,不同年龄段与产次的孕妇感染率无显著差异,P>0.05;孕次达到或超过3次者的HR-HPV感染率为21.0%,大于3次以下者(16.0%),差异显著,P<0.05。1年后共450例感染者接受随访,其中115例孕妇的HR-HPV DNA检测仍然为阳性,持续感染率为25.6%。随访产妇中行剖宫产者与顺产者的持续感染率(27.0%和17.6%)无显著差异,P>0.05。细胞学检查显示,HR-HPV持续感染者中,74例为正常/炎症,另外HSIL 3例,LSIL 5例,ASCUS 33例。41例异常者的病理学检查显示,CINⅠ13例,CINⅡ3例,CINⅢ6例,炎症/湿疣变19例。结论:孕次达到或超过3次者的妊娠晚期感染HRHPV的几率较高,分娩后大部分孕妇会HR-HPV转阴,分娩方式不会影响自然转归,对于持续感染者需行病理学、阴道镜、细胞学检查,避免病情恶化。
Objective: To study the status of HR-HPV infection and natural prognosis in the third trimester of pregnancy. Methods: From May 2013 to May 2014, 2875 pregnant women undergoing maternity and childbirth during pregnancy were selected. Liquid-based cytology and cervical HR-HPV DNA testing were performed at 1 year before pregnancy and before delivery. The infection rate and influencing factors of HR-HPV were statistically analyzed. Follow-up was used to understand the natural outcome and pathology, colposcopy and cytology of persistent infection. Results: A total of 530 pregnant women were infected with HPV, the infection rate was 18.4%. There was no significant difference in the infection rates among pregnant women of different ages and births (P> 0.05). The HR-HPV infection rate was 21.0% , More than 3 times (16.0%), the difference was significant, P <0.05. A total of 450 infected patients were followed up, of which 115 cases of pregnant women HR-HPV DNA test was still positive, the sustained infection rate was 25.6%. There was no significant difference in the persistent infection rate (27.0% vs 17.6%) among the cesarean section and the cesarean section in the follow-up maternity, P> 0.05. Cytological examination showed that among HR-HPV persistent infections, 74 were normal / inflammatory, 3 were HSIL, 5 were LSIL and 33 were ASCUS. The pathological examination of 41 cases of abnormalities showed that 13 cases of CINⅠ, 3 cases of CINⅡ, 6 cases of CINⅢ, and 19 cases of inflammation / condyloma acuminatum. CONCLUSIONS: The third trimester pregnancies have a higher risk of HRHPV infection in the third trimester of pregnancy. Most pregnant women turn negative HR-HPV after childbirth, and the mode of delivery will not affect the natural outcome. For persistent infection, pathology, Colposcopy, cytology, to avoid deterioration of the disease.